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Three-column osteotomy by single-stage posterior approach in congenital and post-tubercular kyphosis: a comparison of outcomes

Abstract

Purpose

To compare the clinical, radiological and functional outcomes of three-column osteotomy (3CO) by a single-stage posterior approach in patients with isolated congenital angular kyphosis (CK) and healed post-tubercular kyphosis (PTK).

Methods

The hospital records of 30 patients with isolated congenital kyphosis (Group CK) and 51 patients with healed post-tubercular kyphosis (Group PTK), operated at a single centre utilizing a 3CO by a single-stage posterior-only approach, were retrospectively analysed. The two groups were compared with respect to selected demographic variables with clinical, radiological and functional outcome measures at a minimum follow-up of 24 months.

Results

Patients in Group CK (median: 13 years, range: 4–30 years) presented earlier than those in Group PTK (median: 16 years, range: 6–45 years). The apex of the deformity was most often located in the thoracic spine in Group PTK, and in the thoracolumbar or lumbar spine in Group CK. The mean operative time (198.2 ± 31.5 min v/s 174.4 ± 34.5; p = 0.01) and estimated blood loss (859.6 ± 312.2 ml v/s 720.8 ± 187.3; p = 0.04) were significantly higher in Group PTK. While the local kyphosis angle was significantly corrected with surgery in both groups, the correction was significantly better in Group CK—this group also had significantly better overall functional (SRS-22r) scores at a follow-up of 24 months (p < 0.05). The overall complication rate (29.4% v/s 23.3%) and neurological complication rate (9.8% v/s 6.6%) were higher in Group PTK. Permanent neurological deterioration occurred in one patient in each group.

Conclusion

Patients with PTK have significantly higher age of presentation, higher operative time and higher complication rate as compared to CK. However, good functional outcomes and kyphosis angle correction can be achieved in both the groups with posterior-only three-column osteotomies.

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Funding

No external funding was used for the study.

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Authors and Affiliations

Authors

Contributions

Concept and design: BG; intellectual content: BG, TB, NM; literature search: TB; data acquisition: TB, NM; data analysis: BG, TB, NM; manuscript preparation: TB, NM; manuscript editing: BG, TB, NM; approval of final version of manuscript: BG, TB, NM; accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work: BG, TB, NM.

Corresponding author

Correspondence to Tungish Bansal.

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Conflict of interest

Dr. Bhavuk Garg, Dr. Tungish Bansal, and Dr. Nishank Mehta declare that they have no conflict of interest.

Ethical approval

Approval was obtained from the Ethics Committee of All India Institute of Medical Sciences, New Delhi. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Patients signed informed consent regarding publishing their data and photographs.

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Garg, B., Bansal, T. & Mehta, N. Three-column osteotomy by single-stage posterior approach in congenital and post-tubercular kyphosis: a comparison of outcomes. Spine Deform 10, 883–892 (2022). https://doi.org/10.1007/s43390-022-00491-y

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Keywords

  • Tuberculosis
  • Kyphosis
  • Post-tubercular
  • Spinal deformity
  • Congenital kyphosis
  • Posterior approach